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Blood Transfusion Informed Consent
Blood Transfusion - Informed Consent and Consumer Information * This guideline is to be used in conjunction with the RCH Blood Transfusion Procedure Introduction This clinical practice guideline addresses the process of informed consent required prior to administration of fresh blood products in the non emergent setting Purpose The purpose of this guideline provides a framework for clinicians prescribing fresh blood products for all patients at The Royal Children's Hospital and should be used in conjunction with the RCH Blood Transfusion Procedure. Definition of Terms Fresh blood products include: ** Red Blood Cells (RBC) ** Platelets (Plts) ** Fresh Frozen Plasma (FFP) ** Cryoprecipitate (Cryo) Fractionated Blood Products ** Albumex 4% and 20% ** Intragam P ** CSL Immunoglobulins ** Biostate ** Thrombotrol ** Prothrombinex ** Monofix Standards The administration of fresh blood products is governed by the standards and recommendations published by World Health Organisation (WHO), Australian Red Cross Blood Service (ARCBS), National Health and Medical Research Council (NHMRC), Australian Council for Healthcare Standards (ACHS) and Australia New Zealand Society of Blood Transfusion (ANZSBT). Informed Consent Prior to a transfusion being administered to a patient the prescribing Doctor will have had a conversation with the parent/patient to inform them of the ** Indications and Benefits of Transfusion ** Risks of Transfusion ** Risks of not having the recommended transfusion ** Any alternative treatments to transfusion that are appropriate This conversation should include the opportunity for the parent/ patient to ask any questions they may have about the transfusion, risks or alternatives. This conversation should be documented in the medical record on the hospital consent form MR 635/A. The consent for blood transfusion must be stored in the patients electronic scanned medical record (ESMR). To find the patients transfusion consent, search the ESMR by type of document to find the folder for "consents", and then review all of the consent documents in that folder. Frequency of consent This document will be stored in the front of the history behind the alert sheet. The Medical Officer should clearly state in the section "consent to the following procedure(s)" Blood transfusion and specify which products they are referring to Platelets, Red Blood cells, FFP and Cryoprecipitate Acute patients: patients who are receiving a single transfusion associated with surgery or some other medical condition should be consented prior to this episode of transfusion. This consent will remain valid for the remainder of the admission. Chronic patients: Patients from Oncology/haematology or patients undergoing regular/frequent transfusions should be consented at the commencement of their treatment or as their condition evolves and the indication for transfusion changes This consent will generally remain valid for 12 months unless there is a significant change in the indication or risk profile of transfusion Emergency Transfusions: will be administered and consent sort at the earliest opportunity. (These patients and families should be provided with the consumer information booklets available for pre transfusion consent). Guide for providing informed consent The following information is provided as a guide to assist you in gaining informed consent for blood transfusion. In non-urgent situations a discussion should take place with the parent(s) about what a blood transfusion involves and the risks. The discussion should include the following: Explain ** Why are you recommending a transfusion? ** Benefits expected of the transfusion ** What is the product and what does it do ** Alternatives *** Are any available (for example the use of iron for treatment of iron deficiency anaemia) and if so why are you recommending transfusion? *** Blood donation from a family member (those wanting directed donation need to be referred to on call haematologist, this process takes a few weeks to complete and is only suitable for planned transfusions i.e. For major surgery) ** Risks *** Low risk, but serious e.g. viral transmission *** Common but not serious e.g. headache, fever *** Receiving the wrong blood *** The risk of not transfusing ** Provide written information which can be accessed through clinical areas, or the Transfusion Clinical Nurse Consultant ** Ask, the parent/care giver if there are any questions ** Document the consent process: *** On the operative consent form MR635/A if there is reasonable likelihood of transfusion during surgery and *** A brief note in the medical history General Risks of Transfusion Link to Transfusion Medicine Manual ARCBS The commonest causes of transfusion reactions seen at The Royal Children's Hospital are fever, chills, hives and red rashes, these occur in approximately 1% of all blood transfusions. The incidence can increase to 10% in children who are chronically transfused. Circulatory overload is a risk for those patients already in a high risk group for circulatory overload, for example neonates, cardiac patients. The following information is provided as guidance, in order to provide you with the relevant information in the event that you are asked questions. Fractionated blood products derived from human plasma (e.g.. immunoglobulins, albumin) include viral inactivation steps and therefore the viral risks are much lower. There have been no documented cases of viral transmission with albumin, and no cases of viral transmission with Australian IVIG. Description of transfusion related adverse events Reference: ARCBS Blood Component Information Booklet 2012. Risk of transmission of viral infection from blood products Notes: vCJD=variant Creutzfeldt-Jakob Disease; (a) The risk estimates for HIV, HCV, HBV are based on Blood Service data from 1 January 2007 to 31 December 2009. The risk estimate for HTLV 1/2 is based on data from 1 January 2004 to 31 December 2009. Reference: ARCBS Blood Component Information Booklet 2012. The Calman Chart. (Calman 1996) for explaining risk (UK risk per one year). Reference: ARCBS Blood Component Information Booklet 2012. Links ** RCH Blood Transfusion Procedure ** Kids Health Info, parent info leaflet ** Blood transfusion website ** A parents guide to transfusion ** Voyages Comic ** Amazing you ** Transfusion Consumer Information in languages other than English